Active NPI
Tyler Douma
- Pharmacist
- Depew, NY
National Provider Identifier
1699454074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RI04312700
- Practice address
- 578 Dick Rd
Depew, NY 14043-1846 - Phone
- (716) 683-9870
- NPI assigned
- Jul 13, 2023
- Last updated
- Jan 8, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28RI04312700 | NJ | Primary |
Addresses
Primary practice location
578 Dick Rd
Depew, NY 14043-1846
Mailing address
83 Chamberlain PL
Midland Park, NJ 07432-1624
Phone (201) 248-6024
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI04312700 | NJ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736294400000",
"number": "1699454074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "83 CHAMBERLAIN PL",
"city": "MIDLAND PARK",
"state": "NJ",
"postal_code": "074321624",
"telephone_number": "201-248-6024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "578 DICK RD",
"city": "DEPEW",
"state": "NY",
"postal_code": "140431846",
"telephone_number": "716-683-9870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUMA",
"first_name": "TYLER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-13",
"last_updated": "2025-01-08",
"certification_date": "2025-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI04312700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Depew, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.